HRT use plummets after link to cancer

The number of Australian women using hormone replacement therapy (HRT) has almost halved since a controversial study suggested the treatment increased a patient's risk of breast cancer.

A report released yesterday in the US shows an even more dramatic decline has occurred in that country, with the popularity of one common treatment falling by 66 per cent since June 2002.

The decline is being attributed to findings from the American Women's Health Initiative (WHI) study, which reported that HRT increased the chance of heart disease, stroke and breast cancer in long-term users.

It also found HRT was no more successful than placebos in treating a woman's physical or emotional health, not to mention pain, energy levels, memory, sleeping patterns or sexual satisfaction.

The trial, in which more than 16,000 women participated, was immediately stopped following the release of the findings in June 2002.

Figures from the Australian Health Insurance Commission show HRT treatment in Australia has declined significantly since then, after many years of increasing use. In the four years to June 2002, prescriptions written in Australia for Kliogest - a common oestrogen and progestin combination treatment - increased by 255 per cent.

However, over the following year its rate of prescription fell by more than a third.

Even HRT treatments the American study found to have no adverse effects, such as those that contain oestrogen alone, are being prescribed less.

In Australia and the US, prescription rates for Premarin, a widely used oestrogen supplement, have declined by 28 and 33 per cent respectively.

Professor Henry Burger, from Monash University's Jean Hailes Institute, said he expected the decline would be short-lived. Further research was likely to discredit the WHI research and women were likely to decide the treatment's benefits outweighed any associated risk.

"It is totally illogical that prescriptions of these treatments should have fallen," he said. "It's definitely influenced people's thinking, and I think this is grossly and totally wrong that it has, as the [WHI] study's been misrepresented and misinterpreted."

Professor Burger said the reliability of the study results were questionable, as an increased risk of breast cancer was found only among women who used HRT for more than five years, and the women in the trial were much older than those who used HRT in Australia.

"As journals publish more articles critical of the WHI study and women realise we have nothing else that works, they will go back and try it again, and I think the pendulum is going to swing the other way."

The chairman of women's health at the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Dr James Brodribb, said many women had chosen to come off HRT treatments because the symptoms that led them to try it were no longer present.

"The difficulty is that a lot of controversy still surrounds this issue, but doctors and patients are definitely becoming more informed," he said. "I think a lot doctors may be asking their patients, 'Do you really still need to be on this?' It's good for doctors to reassess situations, and this [WHI study] may have given them the impetus to do this."

Back in 2002, when Carol McIntosh was asked to describe the dilemma caused by the WHI study on HRT, she was better qualified to speak on the issue than anyone realised.

The Herald interviewed Ms McIntosh - a long-term HRT user - after a study found that HRT increased a patient's risk of breast cancer. She was unsure how to respond, as she believed the quality of life afforded to her by HRT outweighed the risk of developing cancer.

Eighteen months later, Ms McIntosh, 65, feels the same way, despite having lost a breast to cancer in the interim. She has had to stop HRT because she is on the breast cancer treatment Tamoxifen.

"Maybe taking hormones did aggravate the situation," she said. "But having said that, I had nine years of feeling really good; and who's to say that if I'd come off after five years as they recommend, that I wouldn't have struggled and struggled through four years only to have the same result?"

She said that women "should still be comfortable using HRT so long as they remain vigilant and have regular breast checks and mammograms".

Ms McIntosh has a 50 per cent chance of having a cancer in her other breast.